Provider Demographics
NPI:1851066872
Name:PULASKI EYE CARE, INC.
Entity Type:Organization
Organization Name:PULASKI EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:FORT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:629-235-4230
Mailing Address - Street 1:1125 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-4520
Mailing Address - Country:US
Mailing Address - Phone:931-363-4557
Mailing Address - Fax:
Practice Address - Street 1:1125 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4520
Practice Address - Country:US
Practice Address - Phone:931-363-4557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ052848Medicaid
TN1427088178Medicaid